Kornimate/medical-research-clean huggingface dataset:
effects of intranasal insulin on neuroimaging markers and cognition in patients with psychotic disorders

Conditions: Psychosis; Schizophrenia; Schizo Affective Disorder; Bipolar I Disorder

Summary: this clinical trial is a single center, single dose study of the acute effects of intranasal insulin on energy metabolism and cognitive function in patients with schizophrenia, schizoaffective and bipolar disorders, compared and healthy controls.

psychotic disorders are common and severe psychiatric disorders. despite advances in understanding the pathophysiology of these disorders, more effective and tolerable treatments are still needed. evidence suggests that energy metabolism is altered in psychotic disorders. the investigators recently developed non-invasive mri-based techniques to quantify redox balance and atp generation in the brain. targeting insulin pathways in the brain may allow for modulating abnormalities in energy metabolism. the investigators seek to examine whether intranasal insulin can modulate energy metabolism and improve cognition in patients with psychotic disorders. the study will use magnetic resonance spectroscopy (mrs) technology to measure in vivo energy metabolism processes in the brain, before and after the administration of intranasal insulin. investigators will also measure changes in cognition with the administration of intranasal insulin.

Eligibility criteria:
inclusion criteria: * diagnostic and statistical manual of mental disorders (dsm) diagnoses of schizophrenia, schizoaffective disorder or bipolar disorder with psychotic features or * healthy controls (no history of dsm psychiatric diagnoses, nor history of the same in first-degree relatives) exclusion criteria: * psychiatric hospitalization within the last 4 weeks * unstable/active disease or potential contraindications, such as liver disease, kidney disease, uncontrolled hypertension, significant or unstable medical illness * currently prescribed: antidiabetic agents, including oral antidiabetic medications and insulin, intranasal medication, steroids, weight loss agents * pregnant or breast-feeding, not using an effective form of contraception for at least 3 months, and/or not abstinent for 1 month prior to enrollment * history of significant head injury * contraindication to mri scans (claustrophobia, cardiac pacemakers, metal clips and stents on blood vessels, artificial heart valves, artificial arms, hands, legs, etc., brain stimulator devices, implanted drug pumps, ear implants, eye implants or known metal fragments in eyes, exposure to shrapnel or metal filings, other metallic surgical hardware in vital areas, certain tattoos with metallic ink, certain transdermal patches, metal-containing iuds). * medical conditions preventing blood draws * history of electroconvulsive therapy (ect) or transcranial magnetic stimulation (tms) within the last 3 months * bmi \> 35 or body weight \> 350 lbs or bmi \<18 * dsm diagnosis of substance use disorder in the past month * for healthy controls: * taking medication other than birth control

Keywords: psychosis insulin brain metabolism cognition
a cross-sectional study of the oral health of elderly inpatients in acute and subacute hospitals in northumberland and north tyneside

Conditions: Oral Health

Summary: to provide a point-in-time measurement of the oral health of elderly inpatients across the trust (elderly defined here as over 70 years). this will provide information about the number of teeth, need for restorative and periodontal treatment, and extractions, the health of the oral mucosa, quality of any dentures and hygiene of the teeth and dentures.

such information will allow identification of any problems with oral health in this hospital population, thereby allowing development of strategies and protocols for managing these problems. there have been a number of studies examining these variables in elderly residents in care homes and a few in long term hospital settings (over 1 year admission), but only one in the uk previously in acute hospitals. therefore the published literature is sparse, and requires further data collection. the oral health of the elderly, but particularly the institutionalized, is increasingly recognised for its important relationships with general health, wellbeing and quality of life. this study will provide useful information to address these concerns.

Eligibility criteria:
inclusion criteria: * age 70 or over and admitted to geriatric ward within the study area, able to consent exclusion criteria: * unable to consent, aged under 70
immunology of failing metal-on-metal hip replacement

Conditions: Infection of Total Hip Joint Prosthesis; Implants

Summary: metal-on-metal total hip replacement (mom thr) has been targeted at younger patients with anticipated long-term survival since the bearing surfaces wear less than the traditional metal-on-plastic (mop) replacements. however, the production of metal ions as a result of the wear is a concern because of the possible toxicity to cells. in norwich england a number of different metal-on-metal implants have been trialed of which one, the ultima tps, has had very poor results. a total of 545 patients have had 652 mom thrs with the ultima tps of whom more than 20% have now been revised. there is an ongoing mhra program to screen for problems using mri scans with a technique developed in norwich. investigations so far show massive corrosion in the implants with a catastrophic immune response causing death of cells. this may include death of bone leading to fracture. in a third of patients revised there has been pain but normal plain x-rays. in some patients without pain who have been screened there are abnormal changes on an mri scan. we wish to investigate the immune cells in patients to find out why this has happened. the study will include patients coming for a new hip to act as a comparator, as well as those with a mom thr and patients being revised with mom thrs, and mop thrs. we shall also investigate patients with other mom thrs opportunistically.

to characterize dendritic cell (dc) populations in mom thr patients. dendritic cells are cells that migrate from the circulating blood into tissues and mop up foreign material such as viruses with their abnormal surface makers (antigens)and metal debris, activating specialist white blood cells (such as t cells) that kill viruses and remove abnormal material.

Eligibility criteria:
inclusion criteria: * patients who have undergone ultima tps thrs in norwich * patients with a mop thr under going revision. * patients undergoing primary hip replacement with osteoarthritis * patients with other mom thrs undergoing revision exclusion criteria: * patients undergoing primary thr with rheumatoid arthritis or other inflammatory arthritides, or secondary to infection
clinical outcome after implantation of medicontur liberty 677mty, a multifocal, toric iol

Conditions: Cataract

Summary: the purpose of this study is to evaluate visual outcomes, patient satisfaction and yag capsulotomy rate after implantation of a multifocal toric lens- liberty 677mty - manufactured by medicontur ltd. (zsámbék, hungary),

the purpose of this study is to evaluate visual outcomes, glass independency, visual disturbances (glares, halos), neuronal adaptation and patient satisfaction after implantation of multifocal diffractive apodized toric intraocular lens- liberty 677mty - diffractive-refractive apodized iol based on eps technology manufactured by medicontur ltd. (zsámbék, hungary). the tested iol model, liberty 677mty, has an overall length of 13 mm, an optic diameter of 6.0 mm without haptics angulations but with posterior vaulting. the refractive index of the optic material is 1.46 (at 23°c). the iol is a single-piece-iol, the optic and haptics are made from a hydrophilic acrylic co-polymer with integrated - covalently bound uv absorbent. the iol is produced with yellow filter, covalently bound yellow chromophore. the toric component of liberty 677mty iol is located on the posterior surface of the lens optic. the optic is marked with 2 marks. the marks are positioned exactly in middle between the two loops of haptic at the angulation at the flat axis of toric equivalent. the liberty 677mty is available with cylinder powers of 1.0 diopter (d) to 6.0 d. the iol is designed with sharp edge following 360º to prevent migration of the lens epithelial cells , thereby to prevent pco formation. the trifocality of the lens is provided by the eps technology recently developed by medicontur uses an elevated phase shift on the central diffractive part of the lens in order to cause constructive interference between the 0th (far) and 1st diffractive (near) order, thus creating a 3rd (intermediate) focal point.

Eligibility criteria:
inclusion criteria: - exclusion criteria: * astigmatism less than 1 dpt * irregural astigmatism * diabetic retinopathy * iris neovascularisation * serious intraoperative complications * congenital eye abnormality * glaucoma * pseudoexfoliation syndrom * amblyopia * uveitis * long-term anti-inflammatory treatment * amd (advanced amd) * retinal detachment * prior ocular surgery in personal medical history * corneal diseases * severe retinal diseases (dystrophy, degeneration) * severe myopia (if required iol power is lower than 10 d) * inadequate visualization of the fundus on preoperative examination * patients deemed by the clinical investigator because of any systemic disease. * eye trauma in medical history intraoperative exclusions: * tear in capsulorhexis * zonular dehiscence * posterior capsular rupture * vitreous loss and other unexpected surgical complication
tandem high dose chemotherapy and autologous stem cell rescue for high risk pediatric brain tumors

Conditions: Brain Tumors

Summary: the investigators plan to improve event free survival rate and reduce treatment related toxicities of pediatric patients with high risk/recurrent cns tumors by administrating tandem high dose chemotherapy and autologous stem cell rescue.

high risk/recurrent central nervous system (cns) tumors have a poor prognosis so that tandem high dose chemotherapy (hdct) with hematopoietic progenitor stem cell rescues has been chosen as potentially curative therapy. many institutions have used carboplatin, thiotepa, etoposide (cte) for conditioning regimen of 1st hdct and cyclophosphamide, melphalan (cm) for conditioning regimen of 2nd hdct. our institution applied this regimen to the 38 pediatric patients with high risk brain tumor since 1996. although the 3 year overall survival rate and event free survival rate were improved to 69% and 47.9%, respectively, the results showed relatively high treatment related mortality (trm) rate of 21%. toxicity of this tandem regimen was also reported as being high up to 32% in other researches as well so that this regimen is considered not feasible due to toxicity. in this study, the investigators plan to improve event free survival rate and reduce treatment related toxicities of pediatric patients with high risk/recurrent cns tumors by administrating tandem high dose chemotherapy and autologous stem cell rescue with topotecan, thiotepa, carboplatin (ttc) for 1st hdct and melphalan, etoposide, carboplatin (mec) for 2nd hdct.

Eligibility criteria:
inclusion criteria: 1. high risk pediatric brain tumors newly diagnosed medulloblastoma, cns pnet, atrt, choroid plexus carcinoma, pineoblastoma with residual tumor over 1.5cm2 after operation or with leptomeningeal seeding at diagnosis 2. all high grade or malignant brain tumor, age \< 3 years 3. recurrent embryonal brain tumors, recurrent cns germ cell tumor 4. age : no limitation 5. performance status : ecog 0-2. 6. patients must be free of significant functional deficits in major organs, but the following eligibility criteria may be modified in individual cases. heart: a shortening fraction ≥ 28%. liver: total bilirubin \ 60 ml/min/1.73m2. 7. patients must lack any active viral infections or active fungal infection. 8. patients (or one of parents if patients age \< 20) should sign informed. exclusion criteria: 1. patients who do not reach partial response prior to high dose chemotherapy. 2. pregnant or nursing women. 3. malignant (except brain tumor) or nonmalignant illness that is uncontrolled or whose control may be jeopardized by complications of study therapy. 4. psychiatric disorder that would preclude compliance. 5. patients who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study.

Keywords: brain tumors stem cell transplantation topotecan thiotepa carboplatin melphalan etoposide
the impact of prehospital trauma life support (phtls) on outcome of traffic injury

Conditions: Traffic Accidents

Summary: trauma is the leading cause of death among persons below 60 years of age. it is a well-established belief that optimal treatment in the early phase after trauma has a major impact on mortality, and the implementation of specific educational programs for trauma care have been a widely adopted strategy aimed at improving the outcome. this strategy has high face validity, but the underlying evidence is poor. the prehospital trauma life support (phtls) program was introduced in 1983 aiming to integrate prehospital trauma care with the advanced trauma life support (atls) program. approximately half a million prehospital caregivers in over 50 countries have taken the phtls course. it has been recognized as one of the leading educational programs for prehospital emergency trauma care. however, the scientific support for improved patient outcome from courses such as phtls and atls is limited. according to a cochrane analysis published 2010 there is no evidence to recommend advanced life-support (als) training for ambulance crews. another cochrane analysis concerning atls gave similar results and a recent study indicated even worsened outcome after the implementation of atls. an observational study in the county of uppsala indicated reduced mortality after the implementation of phtls but the estimate was uncertain due to a low overall mortality. the aim of this study is to further investigate the association between phtls training of ambulance crew members and the outcome in trauma patients in a larger study population. to accomplish this the investigators will use an epidemiological semi-individual design applied to all victims of traffic injury that occurred during the implementation period of the phtls course in sweden (1998-2004). four outcomes and subsets of patients will be analyzed: mortality before hospital admission, mortality within 30 days, time to death among survivors to hospital admission and return to work among survivors to hospital discharge.

source population: sweden is divided in 21 administrative regions providing health care (counties). in 2004 sweden had a population of about 9 million inhabitants with an average population density of 20 inhabitants/km2. the emergency medical service (ems)-system: the ambulance staff in sweden consists of registered nurses and emergency medical technician (emt) equivalents (nursing assistants with special ambulance training). statistics: hierarchical random effects models will be used to model the binary outcomes. cox proportional hazards models to analyze the time to event outcomes. the difference in mean predicted outcome between the phtls group and the non-phtls group will be used to estimate the absolute risk reduction.

Eligibility criteria:
inclusion criteria: * primary incident hospital admissions due to traffic accidents or * death due to traffic accidents exclusion criteria: * if a patient appears more than once, all but the first event will be excluded from the dataset.

Keywords: traumatic injuries prehospital trauma life support traffic accidents
ametop - friend and foe a prospective study of the incidence of adverse reactions with ametop

Conditions: Adverse Drug Event

Summary: ametop was introduced into the formulary as it was deemed more efficacious for intravenous cannulation compared to emla. however, the incidences of adverse reactions seemed to be higher compared to other studies. this lead to a prospective observational study to look at the incidence and severity of skin reactions following routine clinical application of ametop.

ametop was introduced into the formulary as it was deemed more efficacious for intravenous cannulation compared to emla. after several critical incidences of adverse reactions that occurred with its application, a departmental audit was carried out to look at the incidence and severity reactions with its application as well as its outcome on intravenous cannulation. the findings of the departmental audit showed that the incidence of adverse reactions seemed to occur more commonly compared to other studies. a prospective observational study was carried out to look at the incidence and severity of skin reactions following routine clinical application of ametop. this study aims to achieve the following: 1. investigate the incidence and severity of adverse skin reactions following topical application of ametop prior to intravenous cannulation 2. assess the success rate of intravenous cannulation 3. identify the possible risk factors associated with adverse skin reaction.

Eligibility criteria:
inclusion criteria: * all paediatric patients presenting for surgery from august 2014 to may 2015 who have had ametop applied prior to intravenous cannulation. exclusion criteria: * any patient who did not have ametop applied or have an intravenous cannula in situ.

Keywords: tetracaine
efficacy and safety of cold snare polypectomy (csp) of intermediate sized colorectal polyps 10-15 mm

Conditions: Colorectal Polyp; Colorectal Adenoma

Summary: colorectal cancer (crc) has become the third most common malignant tumor and is the second leading cause of cancer related deaths worldwide. adenomatous polyps of the colon are possible precursor lesions for crc. screening for crc has been shown effective in preventing crc and related deaths, especially colonoscopy and resection of adenomatous polyps. currently, for intermediate sized polyps 5 - 20 mm hot snare polypectomy (hsp) with the use of electrocautery is conventionally used, causing relevant adverse events including haemorrhage and postpolypectomy coagulation syndrome, but is safe regarding complete resection of the polyp due to burning effect on residual tissue. on the other hand, cold snare polypectomy (csp) has grown popularity. absence of electrocautery makes it technically easier and most important reduces adverse events. csp is recommended as the preferred technique for polyps \<5 mm by the european society of gastrointestinal endoscopy (esge) guidelines. in literature, there is one multicenter trial from japan recommending csp for polyps 4-9 mm (average polyp size 5,4 mm) and only a few case studies for polyps 10-15 mm with inconsistent results, especially regarding the complete resection and pathological evaluation of the specimen. in this feasibility trial, the investigators try to find out if csp with a new designed polypectomy snare is efficient and safe in terms of complete resection (r0), pathological evaluation and adverse events.


Eligibility criteria:
inclusion criteria: * indication for colonoscopy * signed informed consent * at least one polyp of the size 10-15mm * american society of anesthesiologists-classification (asa) i-iii exclusion criteria: * american society of anesthesiologists-classification (asa) iv-vi * inflammatory bowel disease (ibd) * known/suspected invasive colorectal cancer * contraindications for polypectomy * emergency indication for colonoscopy

Keywords: coldsnare polypectomy hotsnare polypectomy intermediate sized polyps
efficacy of acupuncture and electroacupuncture in patients with chronic nonspecific low back pain: randomized clinical trial

Conditions: Low Back Pain

Summary: chronic nonspecific low back pain is a major health and socioeconomic responsible for a high rate of employee absenteeism and reduced functional performance. the use of acupuncture as an alternative therapy in the treatment of low back pain and electroacupuncture to enhance the treatment has been effective; however, there is little evidence of the effectiveness of one over the other.

objective: to compare the effect of acupuncture and electroacupuncture as an alternative therapy in patients with chronic low back pain to be able to identify whether electroacupuncture has more benefits than just acupuncture in the treatment of low back pain to be more widespread with scientific. method: sixty subjects will be randomized into two groups: group acupuncture treatment of low back pain (ag) and group acupuncture with the use of electroacupuncture (eg). the primary clinical outcomes will be pain, assessed with the numerical pain scale and mcgill pain questionnaire and disability assessed with roland morris disability questionnaire. secondary outcomes will be measured with global perception scale of global perceived effect, quality of life using the short-form health survey questionnaire (sf-36), beck depression (beck depression inventory bdi), flexibility, kinesiophobia and through bank wells. the groups will be treated with two weekly sessions lasting about an hour, 6 weeks, totaling 12 sessions. the outcomes will be achieved in the final and initial ratings after six months of treatment completion. data will be collected by a blinded examiner who also has made the allocation of patients to groups.

Eligibility criteria:
inclusion criteria: * chronic low back pain (pain for more than three months) * be between 20-60 years exclusion criteria: * patients with severe spinal * previous surgeries or scheduled * herniated disc * rheumatic disease or infection * pregnancy * metal implants